Foglia Lisa M, Nielsen Peter E, Hemann Eileen A, Walker Suzan, Pates Jason A, Napolitano Peter G, Deering Shad
Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, Washington, USA.
Jt Comm J Qual Patient Saf. 2015 Aug;41(8):370-7. doi: 10.1016/s1553-7250(15)41048-7.
In obstetrics, a nationally accepted set of quality indicators for patient safety was not available in the United States until the development of a set of 10 adverse outcome measures-the Adverse Outcome Index (AOI). The National Perinatal Information Center (NPIC) developed hospital discharge data-based algorithms combined with a small set of supplemental patient data for calculation of the AOI. A study was conducted to determine the specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) of the AOI by using the National Perinatal Information Center (NPIC) algorithm.
A retrospective chart review of 4,252 obstetrical and neonatal charts from 2003 through 2007 was performed. NPIC definitions were compared with the "gold standard"-chart review.
A total of 229 deliveries among the 4,000 randomly selected charts had at least one adverse outcome, reflecting an AOI of 5.7%. For detection of the 10 adverse outcomes within the AOI, the overall sensitivity of the AOI was 81.7%, specificity was 98.2%, PPV was 86.3%, and NPV was 97.4%. The Kappa value for agreement between the coded charts and the chart review was 0.82 (standard deviation=0.01, 95% confidence interval [CI]=0.80-0.85), which is considered very good.
The AOI is highly reliant on accurate coding and provider documentation and requires validation with manual chart review. Concurrent chart review improves the accuracy of the AOI. Caution is advised when using the AOI as an exclusive measure of assessing obstetric quality because it may be heavily influenced by a single outcome measure; perineal laceration rates represented twice the frequency of all other outcomes combined. The AOI should be modified to better measure preventable adverse events and include a means of accounting for preexisting conditions.
在美国，直到一套包含10项不良结局指标的不良结局指数（AOI）问世，才出现了一套全国公认的产科患者安全质量指标。国家围产期信息中心（NPIC）开发了基于医院出院数据的算法，并结合少量补充患者数据来计算AOI。本研究旨在通过使用国家围产期信息中心（NPIC）算法来确定AOI的特异性、敏感性、阳性预测值（PPV）和阴性预测值（NPV）。
对2003年至2007年的4252份产科和新生儿病历进行回顾性图表审查。将NPIC定义与“金标准”——图表审查进行比较。
在随机抽取的4000份图表中，共有229例分娩至少出现了一项不良结局，AOI为5.7%。对于检测AOI中的10项不良结局，AOI的总体敏感性为81.7%，特异性为98.2%，PPV为86.3%，NPV为97.4%。编码图表与图表审查之间的一致性Kappa值为0.82（标准差=0.01，95%置信区间[CI]=0.80 - 0.85），这被认为非常好。
AOI高度依赖准确的编码和提供者的记录，并且需要通过人工图表审查进行验证。同时进行图表审查可提高AOI的准确性。在将AOI用作评估产科质量的唯一指标时应谨慎，因为它可能受到单一结局指标的严重影响；会阴裂伤率是所有其他结局总和的两倍。应修改AOI以更好地衡量可预防的不良事件，并纳入一种考虑既往疾病的方法。
